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Cushing’s Syndrome and Disease
For the diagnosis, treatment, and prognosis of Cushing’s syndrome and disease, see the discussion of these disorders in the Adrenal Protocols section.
Hyperprolactinemia [A]
Signs and Symptoms [B]
- Anxiety, depression, irritability
- Weight gain
- In women, since excess PRL causes an increase in the estrogen/progesterone ratio, menstrual cycle irregularities, amenorrhea, anovulation, infertility, and ovarian cysts (PCOS) are possible. Hyperandrogenism and insulin resistance are also symptoms of elevated progesterone/estrogen ratio.
- In men, excess PRL is associated with low libido and erectile dysfunction.
Medical History - A history of acute or chronic stress (physical or psychological) is common, as stress increases pituitary PRL release.
- Sexual activity, pregnancy, high levels of exercise, and sleep also increase PRL.
- Certain medications, such as tricyclic antidepressants, methyldopa, phenothiazines, opiates, MAO inhibitors, reserpine, metoclopramide, and haloperidol, increase PRL release.
- Cortisol, thyroid hormones, progesterone, L-Dopa, PGE1, GABA, and the medication bromocriptine all inhibit PRL release.
- Primary hypothyroidism must be ruled out.
- Headaches and visual disturbances.
- Galactorrhea may indicate the presence of a prolactinoma.
Laboratory Tests - Serum prolactin, elevated estrogen/progesterone ratio in women
- Absence of ovulatory thermal shift on a BBT chart
- FSH and LH may be suppressed
- Visual-field testing
- CT or MRI is used to identify tumors or microadenomas
Therapeutics
Hyperprolactinemia Botanicals and Nutraceuticals
| Herb/Nutrient | Indication/Action | Dose |
| Vitamin B-6 (Pyridoxal-5-Phosphate) | Cofactor in dopamine synthesis, which is a key inhibitor or PRL | 100-200 mg per day |
| Magnesium | Cofactor in B6 and dopamine metabolism | 500 mg per day |
| Vitex agnus castus (Chaste Berry) | Well-studied progesterogenic effects and inhibitor of PRL secretion | 180-240 mg per day of standardized extract |
| GLA | Stimulates PG1, which supports dopaminergic activity | 200-300 mg per day |
| Indole-3-Carbinole (I3C) | Assists the liver in metabolizing estrogens | 300 mg per day |
| Lipotrophic Factors | Inositol, choline, and methionine combination helps detox steroid hormones | 500 mg t.i.d. with meals |
| GABA | Neurotransmitter found to decrease PRL secretion and counter stress | 500 mg t.i.d. |
| Bio-identical Progesterone Cream | Corrects imbalance of estrogen/progesterone ratio | 0.25-0.5 tsp transdermal cream beginning after ovulation until period begins (day 15 to day 28) |
Prognosis [B]
In idiopathic hyperprolactinemia, progression to pituitary prolactinoma seldom, if ever, occurs. When followed for longer than 7 years, 90% to 95% of microadenomas remained stable or gradually decreased prolactin secretion. One third of patients with idiopathic hyperprolactinemia may experience resolution without treatment, and we believe this number increases substantially with naturopathic approaches. Surgery often is not curative for macroprolactinomas, with a recurrence rate of as high as 40% within 5 years. Recurrence rates of hyperprolactinemia are as high as 80%, and, subsequently, patients require long-term medical therapy.